ROSH Gastrointestinal Practice Exam

What clinical finding indicates the presence of acute cholecystitis?

1. Gallbladder wall thickening

2. Pneumoperitoneum

3. Liver lesions

4. Normal liver enzymes

The correct answer is: Gallbladder wall thickening

The presence of gallbladder wall thickening is a significant clinical finding that indicates acute cholecystitis. This thickening is typically a response to inflammation of the gallbladder wall, which can occur when there is obstruction of the cystic duct, most often due to gallstones. The inflammatory process leads to increased blood flow and edema within the wall of the gallbladder, which is visible on imaging studies such as ultrasound or CT scans. In the context of acute cholecystitis, other factors may also be considered, such as the presence of pericholecystic fluid or changes in gallbladder size. However, wall thickening is one of the key features that can help radiologists and clinicians confirm the diagnosis. The other options, while they may relate to different conditions or complications, do not specifically indicate acute cholecystitis. For instance, pneumoperitoneum suggests perforation of an abdominal organ, which is unrelated to the inflammatory state of the gallbladder. Liver lesions may indicate a range of hepatic pathologies, and normal liver enzymes do not provide information regarding the gallbladder's inflammation. Thus, the detection of gallbladder wall thickening is paramount in confirming acute cholec